Chronic Care Management for Long-Term Care — Powered by PointClickCare + CCN Health

CCM for Long-Term Care with PointClickCare and athenahealth

Many long-term care facilities use PointClickCare as their facility EHR while the ordering physician or medical director uses athenahealth for their practice. This dual-EHR reality creates challenges for CCM programs — clinical data lives in two systems that don't natively talk to each other. CCN Health solves this by integrating with both systems simultaneously.

The Dual-EHR Challenge in Long-Term Care

In long-term care settings, it's common for:

• The facility to use PointClickCare for resident records, charting, and daily care documentation
• The physician to use athenahealth for orders, billing, and clinical decision-making
• CCM data to be needed in both systems for complete clinical documentation

Without an integration bridge, nursing staff must manually enter data in both systems, leading to documentation gaps, billing delays, and clinical risk.

How CCN Health Bridges PointClickCare and athenahealth

CCN Health's platform sits between both EHR systems, serving as a central hub for all CCM data:

1. Device data flows to CCN Health — Vital signs from monitoring devices are captured by the CCN Health platform
2. PointClickCare receives resident records — Vital signs, alerts, and care documentation sync to PCC resident charts
3. athenahealth receives clinical summaries — The ordering physician gets CCM reports, clinical observations, and billing-ready documentation in their athenahealth workflow
4. Billing documentation routes correctly — Claims data goes to the billing entity (physician practice via athenahealth) with supporting clinical documentation

Data Flow: PointClickCare ↔ CCN Health ↔ athenahealth

Data Type	PointClickCare	CCN Health	athenahealth
Resident Demographics	Source	Syncs	Receives
Vital Signs	Receives	Hub	Receives
Clinical Alerts	Receives	Generates	Receives
Care Plans	Shared	Coordinates	Shared
Billing Documentation	Reference	Generates	Primary
CCM Time Tracking	Reference	Tracks	Primary

Why This Matters for Long-Term Care

Sustained Monitoring

Continuous vital sign trending over long stays enables early detection of gradual health changes.

Hospitalization Prevention

Proactive alerts help clinical teams intervene before conditions deteriorate to emergency levels.

Documentation Continuity

Automated charting creates a continuous record that supports longitudinal care planning.

Billing Considerations for Dual-EHR CCM

In dual-EHR environments, billing typically flows through the physician practice (athenahealth):

CPT Code	Reimbursement	Billing Entity	Documentation Source
99490	~$62/mo	Physician (athenahealth)	CCN Health → athenahealth
99491	~$83/mo	Physician (athenahealth)	CCN Health → athenahealth

CCN Health ensures all required documentation is routed to the correct system for compliant billing regardless of which entity submits the claim.

Frequently Asked Questions

Do both EHR systems get the same CCM data?

Both systems receive CCM data, but the content is tailored to each system's role. PointClickCare gets resident care documentation, while athenahealth receives clinical summaries and billing records.

Who submits the Medicare claims?

Typically the physician practice bills through athenahealth, with CCN Health providing all required documentation. The specific billing arrangement depends on your organization's structure.

Is there extra setup for dual-EHR integration?

CCN Health configures both integrations during the standard implementation period. The dual-EHR setup is part of our standard offering — no additional cost or extended timeline.